Healthcare Provider Details

I. General information

NPI: 1558054577
Provider Name (Legal Business Name): MS. KIMBERLY HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 LINCOLN RD
MEDWAY OH
45341-1521
US

IV. Provider business mailing address

1513 LINCOLN RD
MEDWAY OH
45341-1521
US

V. Phone/Fax

Practice location:
  • Phone: 937-926-9123
  • Fax:
Mailing address:
  • Phone: 937-926-9123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: